Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Sunday, May 06, 2007

Once in a while all the years of training and practice make a difference in the blink of an eye. Once in a while the patient dying is young and otherwise healthy. Once in a while we make a good save.

First I must tell you that the patient in this post was diagnosed by the triage nurse and then my charge nurse acted right away to get her back and I merely did what I was trained to do, but boy, with a good result it sure feels good.

Betsy is 27 and she was pregnant with her first child. She was eating dinner when she had a sharp pain in her abdomen. She quickly became weak and ill and, being a hardy sort, didn't want her husband to call the ambulance. He insisted in getting her to us and he pulled up in the ambulance bay with her in the passenger's seat. She attempted to get out of the car but collapsed on the pavement. She was rolled in to the ED and my charge nurse told me that a doctor was needed in bed 11 because the patient likely had a ruptured ectopic pregnancy.

I came into the room to see a young girl slumped in the wheelchair with eyes open and looking as pale as Casper the ghost. Her systolic pressure was 60. Training took over; two large bore IVs, stat type and cross two units of packed red cells (and by the way be ready to give trauma blood in a pinch), normal saline wide open, ultrasound to the bedside, all the abdominal organs floating in fluid, page the OBGYN stat, pain relief, quick speech to the patient and her husband, quick bimanual pelvic exam, OBGYN in the room in five minutes, confirmatory trans-vaginal ultrasound at the bedside, operating room consent, labs sent, blood pressure responding to saline, get those piercings out (had to remove the labial piercing with wire cutters from the maintenance tool box), patient rolling to the OR, and one hour later she was in recovery from her ex-lap and unilateral salpingectomy and evacuation of her ruptured ectopic pregnancy. She was in the ED for ten minutes. She had two liters of blood in her abdomen and would have died if she had waited just a few minutes more.

I went to see her a few days ago and she and her hubby were sitting in their room watching Seinfeld and laughing. She looked great. She still has one functioning fallopian tube and should be able to have children. Now this is what we train for; this is Emergency Medicine (and nursing, and OBGYN). She never once asked for pain medicine God bless her.